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Original Investigation |

Patterns of Heterotypic Continuity Associated With the Cross-Sectional Correlational Structure of Prevalent Mental Disorders in Adults ONLINE FIRST

Benjamin B. Lahey, PhD1,2; David H. Zald, PhD3,4; Jahn K. Hakes, PhD5; Robert F. Krueger, PhD6; Paul J. Rathouz, PhD7
[+] Author Affiliations
1Department of Health Studies, University of Chicago, Chicago, Illinois
2Department of Psychiatry and Behavioral Neuroscience, University of Chicago, Chicago, Illinois
3Department of Psychology, Vanderbilt University, Nashville, Tennessee
4Department of Psychiatry, Vanderbilt University, Nashville, Tennessee
5US Census Bureau, Suitland, Maryland
6Department of Psychology, University of Minnesota, Minneapolis
7Department of Biostatistics and Medical Informatics, University of Wisconsin School of Medicine and Public Health, Madison
JAMA Psychiatry. Published online July 02, 2014. doi:10.1001/jamapsychiatry.2014.359
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Importance  Mental disorders predict future occurrences of both the same disorder (homotypic continuity) and other disorders (heterotypic continuity). Heterotypic continuity is inconsistent with a view of mental disorders as fixed entities. In contrast, hierarchical-dimensional conceptualizations of psychopathology, in which each form of psychopathology is hypothesized to have both unique and broadly shared etiologies and mechanisms, predict both homotypic and heterotypic continuity.

Objective  To test predictions derived from a hierarchical-dimensional model of psychopathology that (1) heterotypic continuity is widespread, even controlling for homotypic continuity, and that (2) the relative magnitudes of heterotypic continuities recapitulate the relative magnitudes of cross-sectional correlations among diagnoses at baseline.

Design, Setting, and Participants  Ten prevalent diagnoses were assessed in the same person twice (ie, in 2 waves separated by 3 years). We used a representative sample of adults in the United States (ie, 28 958 participants 18-64 years of age in the National Epidemiologic Study of Alcohol and Related Conditions who were assessed in both waves).

Main Outcomes and Measures  Diagnoses from reliable and valid structured interviews.

Results  Adjusting for sex and age, we found that bivariate associations of all pairs of diagnoses from wave 1 to wave 2 exceeded chance levels (P < .05) for all homotypic (median tetrachoric correlation of ρ = 0.54 [range, 0.41-0.79]) and for nearly all heterotypic continuities (median tetrachoric correlation of ρ = 0.28 [range, 0.07-0.50]). Significant heterotypic continuity was widespread even when all wave 1 diagnoses (including the same diagnosis) were simultaneous predictors of each wave 2 diagnosis. The rank correlation between age- and sex-adjusted tetrachoric correlation for cross-sectional associations among wave 1 diagnoses and for heterotypic associations from wave 1 to wave 2 diagnoses was ρ = 0.86 (P < .001).

Conclusions and Relevance  For these prevalent mental disorders, heterotypic continuity was nearly universal and not an artifact of failure to control for homotypic continuity. Furthermore, the relative magnitudes of heterotypic continuity closely mirrored the relative magnitudes of cross-sectional associations among these disorders, consistent with the hypothesis that both sets of associations reflect the same factors. Mental disorders are not fixed and independent entities. Rather, each diagnosis is robustly related to other diagnoses in a correlational structure that is manifested both concurrently and in patterns of heterotypic continuity across time.

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Figure 1.
Bivariate Cross-sectional Tetrachoric Correlations (SE), Adjusted for Sex and Wave 1 Age, Among Wave 1 Diagnoses in the NESARC Sample

P < .001 for all correlations. Cross-sectional associations within the same second-order class of mental disorders (distress, fears, or externalizing) are displayed in shading. AGP indicates agoraphobia and/or panic disorder; ALC, alcohol dependence; APD, antisocial personality disorder; DYS, dysthymia; GAD, generalized anxiety disorder; MDD, major depressive disorder; NESARC, National Epidemiologic Study of Alcohol and Related Conditions; SOC, social phobia; SPP, specific phobia; SUB, other substance dependence; and TOB, tobacco dependence.

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Figure 2.
Bivariate Tetrachoric Correlations (SE) for Prospective Homotypic and Heterotypic Continuities From Wave 1 Diagnoses to Wave 2 Diagnoses in NESARC, Adjusted for Sex and Age in Wave 1

P < .05 for all correlations, except for wave 1 specific phobia and wave 2 other substance dependence. Tetrachoric correlations for homotypic associations are in bold; prospective associations within the same second-order class of mental disorders (distress, fears, or externalizing) are displayed in shading. AGP indicates agoraphobia and/or panic disorder; ALC, alcohol dependence; APD, antisocial personality disorder; DYS, dysthymia; GAD, generalized anxiety disorder; MDD, major depressive disorder; SOC, social phobia; SPP, specific phobia; SUB, other substance dependence; and TOB, tobacco dependence.

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Figure 3.
Tetrachoric Correlations (SE) [z Scores] Between Each Wave 1 and Wave 2 Diagnosis, Simultaneously Adjusted for Sex, Wave 1 Age, and All Other Wave 1 Diagnoses in NESARC

Tetrachoric correlations for homotypic associations are in bold; prospective associations within the same second-order class of mental disorders (distress, fears, or externalizing) are displayed in shading. AGP indicates agoraphobia and or panic disorder; ALC, alcohol dependence; APD, antisocial personality disorder; DYS, dysthymia; GAD, generalized anxiety disorder; MDD, major depressive disorder; SOC, social phobia; SPP, specific phobia; SUB, other substance dependence; and TOB, tobacco dependence. aP < .001. bP < .05. cP < .01.

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Figure 4.
Bivariate Cross-sectional Age- and Sex-Adjusted Tetrachoric Correlations Among Wave 1 Diagnoses With Bivariate Heterotypic Age- and Sex-Adjusted Tetrachoric Correlations From Wave 1 to Wave 2 Diagnoses in the NESARC Sample

The Spearman rank correlation coefficient is shown. NESARC indicates National Epidemiologic Study of Alcohol and Related Conditions.

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